VERIFICATION BY INSTITUTION:
COMPLETION OF APPROVED EDUCATION PROGRAM
TO THE APPLICANT: Fill in the information above the line. Please type or print.
last name
first name
middle name
street address
maiden name
city
state
zip code
social security number
TO THE DESIGNATED COLLEGE OFFICIAL:
Fill in ONE of the boxes and BOTH sections at the bottom of the page.
The applicant completed requirements for the
bachelor’s
master’s
six year
(educational specialist)
doctorate
The applicant did not earn a degree from this institution but
completed an approved education program at the degree level of
bachelor’s
master’s
six year
(educational specialist)
doctorate
degree and finished an approved education program in
the licensure area(s) of (e.g. elementary education, music,
secondary mathematics, etc.)
in the area(s) of (e.g. elementary education, music, secondary
mathematics, etc.)
Date program completed
Date program completed
month, day, year
month, day, year
The program completed meets the following accreditation, approval, or
program requirements (check all that apply):
●
●
National Council for Accreditation of Teacher
Education (NCATE)
University of North Carolina at Wilmington
National Association of State Directors of Teacher
Education and Certification Standards (NASDTEC)
Ms. Logan Sidbury
designated official (licensure officer, dean of education)
Education program approval by the state of
Internship and Licensure Coordinator
title
name of institution
North Carolina
●
The applicant completed an education program approved in the
area(s) and at the level(s) recommended. The approved program
was in effect during the applicant’s period of study.
signature
Regional accreditation by (name of body)
date
Southern Association of Colleges and Schools
email address
Public Schools of North Carolina
Department of Public Instruction
Licensure Section
6365 Mail Service Center
Raleigh, North Carolina 27699-6365
Form V
August 2008